1. Home
  2. Directory
  3. North Carolina
  4. Raleigh
  5. Community Based Residential Treatment Facility Mental Illness
  6. NPI Profile

DIVINE SUPPORTIVE HOMES INC
NPI 1447776430
Community Based Residential Treatment Facility, Mental Illness in Raleigh, NC

Active since August 21, 2017CLIA 34D2295373 · Waiver
3905 MARSH CREEK RD, RALEIGH, NC 27604(191) 791-9032(919) 791-9032 Get Directions Write a Review

NPPES record last updated: August 21, 2017. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Divine Supportive Homes Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DIVINE SUPPORTIVE HOMES INC (NPI 1447776430) is a healthcare organization registered as a community based residential treatment facility, mental illness in Raleigh, North Carolina and active in the NPI registry since August 2017. The organization holds a CLIA Waiver certificate valid through December 10, 2027 and lists Anthony C Ikejiaku, Manager, as its authorized official.

NPPES Registry Identity

NPI1447776430
Entity TypeOrganization
Primary Taxonomy320800000X
Legal Business NameDIVINE SUPPORTIVE HOMES INC
Location Address3905 MARSH CREEK RDRaleigh, NC 27604-4108
Mailing Address549 Irina DrRolesville, NC 27571-9338 · (919) 791-9032
Phone(191) 791-9032
Fax(919) 791-9032
Organization SubpartNo
Authorized OfficialAnthony C IkejiakuManager · (919) 791-9032
Enumeration DateAugust 21, 2017
✔ NPI 1447776430 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Mental IllnessResidential Treatment Facilities
Taxonomy Code320800000X
License✔ Licensed in NC · MHL-092-539
Definition
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.
3905 MARSH CREEK RD, Raleigh, NC 27604
Open in Google Maps ↗

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D2295373

Devine Supportive Homes · Cary, NC
Active · expires Dec 10, 2027
CLIA Number34D2295373
Laboratory TypeAssisted Living Facility
Certificate Effective DateDecember 11, 2025
Certificate Expiration DateDecember 10, 2027
Laboratory DirectorAnthony C. Ikejiaku
Laboratory Phone(919) 791-9032
Laboratory LocationDevine Supportive Homes604 SE Maynard Road, Cary, NC 27511
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AGAPE FAMILY CARE HOMES, LLC
Assisted Living Facility (Assisted Living, Mental Illness)
3905 MARSH CREEK RD
RALEIGH, NC 27604
Wake County (919) 875-1316

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Divine Supportive Homes Inc's NPI number?

The NPI number for Divine Supportive Homes Inc is 1447776430. It was assigned to this organization in the NPPES registry on August 21, 2017.

Where is Divine Supportive Homes Inc located?

Divine Supportive Homes Inc is located at 3905 Marsh Creek Rd, Raleigh, NC 27604. The listed phone number is (191) 791-9032.

What is Divine Supportive Homes Inc's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Mental Illness with taxonomy code 320800000X.

Does Divine Supportive Homes Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D2295373) is associated with this NPI, valid through December 10, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Divine Supportive Homes Inc was last updated on August 21, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.